Care models for coexisting serious mental health and alcohol/drug conditions: the RECO realist evidence synthesis and case study evaluation.

IF 3.5 2区 医学 Q1 HEALTH CARE SCIENCES & SERVICES
Elizabeth Hughes, Jane Harris, Tom Ainscough, Angela Bate, Alex Copello, Sonia Dalkin, Gail Gilchrist, Emma Griffith, Lisa Jones, Michelle Maden, Luke Mitcheson, Harry Sumnall, Charlotte Walker
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引用次数: 0

Abstract

Background: People with severe mental illness who experience co-occurring substance use experience poor outcome including suicide, violence, relapses and use of crisis services. They struggle to access care and treatment due to a lack of an integrated and co-ordinated approach which means that some people can fall between services. Despite these concerns, there is limited evidence as to what works for this population.

Objectives: To undertake a realist evaluation of service models in order to identify and refine programme theories of what works under what contexts for this population.

Design: Realist synthesis and evaluation using published literature and case study data.

Setting: Mental health, substance use and related services that had some form of service provision in six locations in the United Kingdom (five in England and one in Northern Ireland).

Participants: People with lived experience of severe mental illness and co-occurring substance use, carers and staff who work in the specialist roles as well as staff in mental health and substance use services.

Results: Eleven initial programme theories were generated by the evidence synthesis and in conjunction with stakeholders. These theories were refined through focus groups and interviews with 58 staff, 25 service users and 12 carers across the 6 case study areas. We identified three forms of service provision (network, consultancy and lead and link worker); however, all offered broadly similar interventions. Evidence was identified to support most of the 11 programme theories. Theories clustered around effective leadership, workforce development and collaborative integrated care pathways. Outcomes that are meaningful for service users and staff were identified, including the importance of engagement.

Limitations: The requirement for online data collection (due to the COVID-19 pandemic) worked well for staff data but worked less well for service users and carers. Consequently, this may have reduced the involvement of those without access to information technology equipment.

Conclusion: The realist evaluation co-occurring study provides details on how and in what circumstances integrated care can work better for people with co-occurring severe mental health and alcohol/drug conditions. This requires joined-up policy at government level and local integration of services. We have also identified the value of expert clinicians who can support the workforce in sustaining this programme of work. People with co-occurring severe mental health and alcohol/drug conditions have complex and multifaceted needs which require a comprehensive and long-term integrated approach. The shift to integrated health and social care is promising but will require local support (local expert leaders, network opportunities and clarity of roles).

Future work: Further work should evaluate the effectiveness and cost-effectiveness of service models for this group.

Study registration: This study is registered as PROSPERO CRD42020168667.

Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR128128) and is published in full in Health Technology Assessment; Vol. 28, No. 67. See the NIHR Funding and Awards website for further award information.

严重精神疾病与酗酒/吸毒并存的护理模式:RECO 现实主义证据综述和案例研究评估。
背景:患有严重精神疾病并同时使用药物的患者,其治疗效果不佳,包括自杀、暴力、复发和使用危机服务。由于缺乏综合协调的方法,他们很难获得护理和治疗,这意味着有些人可能会在不同的服务机构之间徘徊。尽管存在这些问题,但有关对这些人群有效的方法的证据却很有限:对服务模式进行现实主义评估,以确定和完善在何种情况下对该人群有效的方案理论:设计:利用已发表的文献和案例研究数据进行现实主义综合评估:环境:英国六个地区(五个在英格兰,一个在北爱尔兰)提供某种形式服务的精神健康、药物使用及相关服务机构:参与者:有严重精神疾病和并发药物使用生活经历的人、照顾者和从事专业工作的人员,以及精神健康和药物使用服务机构的工作人员:结果:通过证据综合以及与利益相关者的合作,提出了 11 个初步的计划理论。通过与 6 个案例研究地区的 58 名工作人员、25 名服务使用者和 12 名照护者进行焦点小组讨论和访谈,对这些理论进行了完善。我们确定了三种服务提供形式(网络、顾问、领导和联系工作者),但所有形式提供的干预措施大体相似。在 11 项计划理论中,我们发现了支持其中大多数理论的证据。这些理论主要围绕有效领导、劳动力发展和合作性综合护理路径。确定了对服务用户和员工有意义的成果,包括参与的重要性:局限性:在线数据收集的要求(由于 COVID-19 大流行)对员工数据的收集效果很好,但对服务用户和护理人员的效果较差。因此,这可能会降低那些无法使用信息技术设备的人的参与度:并发症现实主义评估研究提供了详细资料,说明如何以及在何种情况下,综合护理可以更好地为同时患有严重精神疾病和酗酒/吸毒的人服务。这需要政府层面的联合政策和地方服务的整合。我们还发现了专业临床医生的价值,他们可以支持医疗队伍持续开展这项工作。同时患有严重精神疾病和酗酒/吸毒问题的人有着复杂和多方面的需求,需要采取全面和长期的综合方法。向综合医疗和社会护理的转变是大有希望的,但需要当地的支持(当地的专家领导、网络机会和明确的角色):今后的工作:进一步的工作应评估针对这一群体的服务模式的有效性和成本效益:本研究已注册为 PROSPERO CRD42020168667:该奖项由美国国家健康与护理研究所(NIHR)健康技术评估项目资助(NIHR奖项编号:NIHR128128),全文发表于《健康技术评估》第28卷第67期。更多奖项信息请参阅 NIHR Funding and Awards 网站。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Health technology assessment
Health technology assessment 医学-卫生保健
CiteScore
6.90
自引率
0.00%
发文量
94
审稿时长
>12 weeks
期刊介绍: Health Technology Assessment (HTA) publishes research information on the effectiveness, costs and broader impact of health technologies for those who use, manage and provide care in the NHS.
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